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HomeMy WebLinkAbout10 Highview RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applica' eby: BUILDING DEPARTMENT U APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Bitng Inspector Application must be printed or typed Location of Job: FEE SCHEDULE 0 et 0,601Y 0-$1,000=$15.00 Street N Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT Ari 40AJi k APPLICANT ADDRESS JtA W Iof & ©Go-1 y APPLICANT PHONE# gyy-7 G 7 OWN S OWNER jCGvti t', 4 S 9 0" q OWNER ADDRESS So vwe a C.,Ljt- OOWNER PHONE r r,,, CA S c, C ESTIMATED COST$ ,OQ 0 IS THIS A CONTRACT COST? vllYes No FEE ENCLOSED$90 TYPE OF JOB: SOR-C New Installation Alteratio dditio epair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A K RESIDENTIAL BUILDING PERMIT APPLICATION? YES NO BUSINESS CURRENT USE AND OCCUPANCY k) w, ASSEMBLY CMERCANTILE FUTURE USE AND OCCUPANCY l YtU TGwj l gDo mEDUCATIONAL INSTITUTIONAL FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE CITY STATE ZIP Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE ZDO hm 12 SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES 6 0 NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. Z 0.wty,v lS fit- CONTRACTORS LICENSE NO. TYPE STATE r SIGNATURE OF APPLICANT _ DATE,117V 9-0 2